Welcome to Radical Presence Coaching, a somatic healing practice with Dr. Barbara Ceptus Schreiber, SEP. Join us for a deep dive into the impact of sexual trauma on the mind & body, and discover practical strategies to regulate your nervous system, cultivate calm, and experience greater ease in your daily life.
Please note: The information provided on this form is protected as confidential information.
client
Do you identify as Black, Indigenous, or a Person of Color?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the below options.","options":"Yes\nNo"}
If yes, please specify.
{"type":"text","name":"__generic2","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
The Landing Place is a safe space for women and women aligned people of color. We make space for a range of identities that may fall in this category. Do you identify with this category?
{"type":"radio","name":"__generic5","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the below options.","options":"Yes\nNo"}
What brings you to this healing journey?
{"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
How did you hear about this program?
{"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Do you have any questions before we talk?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Which session are you able to attend?
{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Virtual\nIn-Person\nSaturday Morning\nWednesday Evening"}
I recognize that discussing sexual trauma can be triggering or distressing. While you will NEVER be asked to share your personal trauma history, others may choose to share their experiences. We will offer tools and techniques for self-regulation and care, but your well-being is ultimately your responsibility. Please prioritize your needs and engage in ways that feel safe for you.I recognize that discussing sexual trauma can be triggering or distressing.
{"type":"radio","name":"__generic3","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the below options.","options":"Yes, I understand\nNo, I need further explanation"}